Another Look

Bobby continued to desat through the night. At some point, his saturation fell into the 50s, which is a scary low number. So, they decided to do a cardiac catheterization today.

The cath was inserted into an artery in Bobby's neck and they found what they expected to find - a collateral vein.

Remember that now, the blood from Bobby's head is supposed to be flowing directly to his lungs. That is the only blood that has access to the lungs, and is thus the only means for him to get his blood saturated with oxygen. Bobby had a collateral vein in his head that was still attached to the heart - so it was draining out blood that was meant to be oxygenated and sending it back to the heart where it got recirculated without any lung time.

The catheterization doctor plugged up the offending vein. Now, all of the blood in Bobby's head should be getting oxygenated.

Right now, his sats are a little better. He's still on the ventilator and will be until tomorrow. The vent is hard on his system so we won't get a true read of his improvement until he's been breathing on his own for a bit. Unfortunately, this means another night of uncomfortable suctioning.

He's on an interesting little cocktail of general anasthetic that hasn't worn off, Dopamine, Ativan, Loritab, and Morphine. Its almost as elaborate as my personal drug cocktail (kidding...kidding, Valerie and I gave all that up when we adopted our cats) He's stable and will be kept more or less sedated through the night.

Meanwhile, we have had a string of 3 very good nurses since the debacle last night, all of whom have taken his desats very seriously. Last night's nurse was particularly great. She was getting her shift report when Bobby turned blue so she saw how angry I was. I started the night by telling her, "I'm going to need two things. One, don't lecture me on how to read the monitor and two, don't argue with me about whether Bobby is in pain." She was very gracious. She also taught me a nifty little trick about how to suction the acid from Bobby's reflux back up the feeding tube so that it doesn't sting sweet Bobby. Pretty cool.